Provider Demographics
NPI:1942293055
Name:RIDDLE, ROBBY C (MD)
Entity Type:Individual
Prefix:
First Name:ROBBY
Middle Name:C
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:STE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4934
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4079
Practice Address - Street 1:5952 BLACKSTONE WAY
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-4900
Practice Address - Country:US
Practice Address - Phone:509-464-3627
Practice Address - Fax:509-466-9517
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8860084Medicare PIN
WAG8860086Medicare PIN
WAG8860079Medicare PIN
WAG8860087Medicare PIN
WAG8860085Medicare PIN
WAG8860081Medicare PIN
WAG8860080Medicare PIN
WAG8860078Medicare PIN